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Background: Aboriginal children are at increased risk for obesity and type 2 diabetes. Healthy Buddies [TM]-First Nations (HB) is a curriculum-based, peer-led program promoting healthy eating, physical activity, and self-esteem. Methods: Although originally designed as a pilot pre-/post-analysis of 3 remote Aboriginal schools that requested and received HB training, one school did not implement the program and was used as a control group. Outcomes included changes in body mass index z-score (zBMI), waist circumference (WC), blood pressure (BP), self-esteem, health behavior, and knowledge over 1 school year in kindergarten to grade 12 children. Results: There was a significant decrease in zBMI (1.10 to 1.04, p=0.028) and WC (77.1 to 75.0 cm, p less than 0.0001) in the HB group (N=118) compared with an increase in zBMI (1.14 to 1.23, p=0.046) and a minimal WC change in the control group (N=61). Prevalence of elevated BP did not change in the HB group, but increased from 16.7% to 31.7% in the control group (p=0.026). General linear model analysis revealed a significant interaction between time, group, and zBMI (p=0.001), weight status (p=0.014), nutritious beverage knowledge (p=0.018), and healthy living and self-esteem score (p=0.005). Conclusions: The HB program is a promising school-based strategy for addressing obesity and self-esteem in Aboriginal children. (Contains 3 tables and 2 figures.)

Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children. Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine cardiovascular risk factors and health behaviours in Aboriginal children from the Beaufort-Delta region (Northwest Territories). METHODS: A total of 91 elementary school-age children underwent a cross-sectional assessment of body mass index, waist circumference, blood pressure and aerobic fitness. Healthy living knowledge and behaviours, including frequency of self-reported physical activity (PA) and dietary intake, were also evaluated. RESULTS: A total of 49.5% of children were obese/overweight and 31.9% had elevated blood pressure. The percentages having one, two or three cardiovascular risk factor(s) were 64.4%, 42.2% and 15.6%, respectively, with no significant difference between boys and girls. Overall, the students obtained higher mean scores in the areas of healthy PA, body image, self-esteem and nutritious beverage knowledge (89%, 85%, 79% and 71% of the maximum scores, respectively). The lowest scores were in nutritious food consumption and healthy PA frequency (46% and 56% of the maximum scores, respectively). On average, children consumed 2.7 L of sugar-sweetened beverages weekly and <2 servings of fruits or vegetables daily. Children spent approximately 2 h per day watching television, playing games or using a computer. CONCLUSION: There is an urgent need for community-based approaches to address the high rates of obesity and related cardiovascular risk factors among these Aboriginal children. Given the disconnect between healthy living knowledge and behaviour, it is important that future treatment programs address other barriers faced by Aboriginal populations living in rural and remote regions, including the high cost and limited access to high-quality nutritious foods and beverages, and limited access to indoor recreational programs over the long winter season. [ABSTRACT FROM AUTHOR]

Objectives Childhood type 2 diabetes ( T2 D) is increasing and may present differently across various populations. This study compares clinical features of T2 D at diagnosis in Aboriginal children with Caucasian children and children from other high-risk ethnic groups. Patients and methods This retrospective observational study used data from a Canadian surveillance study where newly diagnosed cases of childhood T2 D were reported (n = 227). Using descriptive statistics, clinical features at diagnosis of T2 D were compared across different ethnic groups including Aboriginal (n = 100), Caucasian (n = 57), and other high-risk ethnic groups (n = 64). Comparisons were made between Aboriginal children living in central Canada ( Manitoba/northwestern Ontario) (n = 74) and Aboriginal children from other regions of Canada (n = 26). Results Aboriginal children were younger, less obese, and less likely to have polycystic ovarian syndrome and dyslipidemia when compared to Caucasian children and children from other high-risk ethnic groups (p < 0.05). Aboriginal children from central Canada vs. those from other regions of Canada did not differ in age, body mass index z-score, family history of T2 D, or presence of acanthosis nigricans. Those from central Canada had lower hemoglobin A1 c levels (p < 0.05) and were less likely to have dyslipidemia than Aboriginal children from other regions (p < 0.05). Conclusions Clinical features and rates of comorbidity in children with newly diagnosed T2 D differ across various populations ( Caucasian, Aboriginal, and children who belong to other high-risk ethnic groups) and across distinct Aboriginal populations (those living in central Canada vs. those living in other regions of Canada). Future research should determine specific genetic and environmental factors that contribute to these differences. [ABSTRACT FROM AUTHOR]

Second-generation antipsychotic medications have been proscribed with increasing frequency since they first became available in Canada in the 1990s. This is due in part to a better side effect profile when these agents are compared with first-generation antipsychotics, particularly with respect to extrapyramidal symptoms. However, serious adverse metabolic side effects are now being reported. In addition, these medications are increasingly being used off-label without clear guidelines for indications, dosing, and monitoring. In British Columbia, one-third of antipsychotic prescriptions are provided by general practitioners. Consequently, there is an urgent need for primary care physicians to be aware of practice guidelines. When proscribing second-generation antipsychotics, physicians should: (1) Ensure the appropriate psychiatric diagnosis is made. (2) Consider target symptoms, approved indications, and degree of functional impairment before initiating treatment. (3) Monitor all patients on a second generation antipsychotic according to approved protocol. (4) Encourage preventive lifestyle practices. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of antipsychotics, especially second-generation antipsychotics (SGAs), for children with mental health disorders in Canada has increased dramatically over the past five years. These medications have the potential to cause major metabolic and neurological complications with chronic use. OBJECTIVE: To synthesize the evidence for specific metabolic and neurological side effects associated with the use of SGAs in children, and provide evidence-based recommendations for the monitoring of these side effects. METHODS: A systematic review of controlled clinical trials of SGAs involving children was performed. Recommendations for monitoring SGA safety were made according to a classification scheme based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. When there was inadequate evidence, recommendations were based on consensus and expert opinion. A multidisciplinary consensus group reviewed all relevant evidence and reached consensus on the recommendations. RESULTS: The present guidelines provide evidence-based recommendations for monitoring SGA safety. The strength of recommendations for specific physical examination manoeuvres and laboratory tests are provided for each SGA medication at specific time points. CONCLUSION: Multiple randomized controlled trials evaluated the efficacy of many of the SGAs in paediatric mental health disorders. These benefits, however, are not without risks - both metabolic and neurological side effects occur in children treated with SGAs. The risk of weight gain, increased body mass index and abnormal lipid levels is greatest with olanzapine, followed by clozapine and quetiapine. The risk of neurological side effects of the treatment is greatest with risperidone, olanzapine and aripip-razole. Appropriate monitoring procedures for adverse effects will improve the quality of care of children treated with these medications. [ABSTRACT FROM AUTHOR]

Objectives: To review the evidence for efficacy and metabolic effects of atypical antipsychotics (AAPs), and to propose a metabolic monitoring protocol for AAP use in children and adolescents. Methods: A PubMed search was performed to obtain all studies related to efficacy, metabolic side-effects, and monitoring in those less than 18 years of age. Results: There are no approved indications for AAP use in children and adolescents in Canada. Based on US Food and Drug Administration approvals and a review of randomized controlled trials, we identified 7 indications for AAP use that target specific symptoms in youth including schizophrenia, bipolar I disorder, autism, pervasive developmental disorder, disruptive behaviour disorders (including conduct disorder and ADHD), developmental disabilities and Tourette Syndrome. A wide range of metabolic effects including weight gain, increased waist circumference, dysglycemia, dyslipidemia, hypertension, elevated hepatic transaminases and prolactin levels have been reported. We have developed a proposal for metabolic monitoring that includes anthropometric measurements and laboratory testing at baseline and appropriate intervals thereafter. Conclusion: There is an urgent need for national clinical practice guidelines that provide, not only appropriate treatment algorithms for AAP use based on evidence, but also address metabolic monitoring and subsequent management of complications in this vulnerable population. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- To determine in Canadian children aged <18 years the 1) incidence of type 2 diabetes, medication-induced diabetes, and monogenic diabetes; 2) clinical features of type 2 diabetes; and 3) coexisting morbidity associated with type 2 diabetes at diagnosis. RESEARCH DESIGN AND METHODS -- This Canadian prospective national surveillance study involved a network of pediatricians, pediatric endocrinologists, family physicians, and adult endocrinologists. Incidence rates were calculated using Canadian Census population data. Descriptive statistics were used to illustrate demographic and clinical features. RESULTS-- From a population of 7.3 million children, 345 cases of non-type 1 diabetes were reported. The observed minimum incidence rates of type 2, medication-induced, and monogenic diabetes were 1.54, 0.4, and 0.2 cases per 100,000 children aged < 18 years per year, respectively. On average, children with type 2 diabetes were aged 13.7 years and 8% (19 of 227) presented before 10 years. Ethnic minorities were overrepresented, but 25% (57 of 227) of children with type 2 diabetes were Caucasian. Of children with type 2 diabetes, 95% (206 of 216) were obese and 37% (43 of 115) had at least one comorbidity at diagnosis. CONCLUSIONS-- This is the first prospective national surveillance study in Canada to report the incidence of type 2 diabetes in children and also the first in the world to report the incidence of medication-induced and monogenic diabetes. Rates of type 2 diabetes were higher than expected with important regional variation. These results support recommendations that screening for comorbidity should occur at diagnosis of type 2 diabetes. [ABSTRACT FROM AUTHOR]